http://hdl.handle.net/10027/762 Thu, 23 May 2013 06:27:59 GMT 2013-05-23T06:27:59Z http://hdl.handle.net/10027/8770 Ability of a neuro-ophthalmologist to estimate retinal nerve fiber layer thickness. Pula, John H.; Kattah, Jorge C.; Wang, Hauping; Marshall, John; Eggenberger, Eric R. BACKGROUND: Qualitative description of the optic disc has clinical value, but optical coherence tomography (OCT) has provided the ability to quantify retinal nerve fiber layer (RNFL) thickness. METHODS: We asked three neuro-ophthalmologists of at least 20 years' experience to estimate the average OCT RNFL thickness of 37 eyes based on fundus photos. RESULTS: The overall correlation coefficient for RNFL thickness estimation variance between two physicians and between physician and OCT was 0.53. The likelihood that the RNFL thickness estimation between physicians, or between physician and OCT, was within 10 μm of each other was 47%-62%. All physicians had disparities in RNFL thickness estimation greater than 30 μm. CONCLUSION: This study provides information on the ability of an experienced neuro-ophthalmologist to estimate the RNFL thickness based on fundus photos. © 2012 by Dove Medical Press, Clinical Ophthalmology Sat, 01 Sep 2012 05:00:00 GMT http://hdl.handle.net/10027/8770 2012-09-01T05:00:00Z http://hdl.handle.net/10027/8752 Nuss Procedure: Decrease in Bar Movement Requiring Reoperation with Primary Placement of Two Bars Stanfill, Amy B.; DiSomma, Nerina; Henriques, Steven M.; Wallace, Lizabeth J.; Vegunta, Ravindra K.; Pearl, Richard H. Background: The Nuss procedure, first reported in 1998, is currently the treatment of choice for pectus excavatum. The most significant bar-related complication documented is bar movement, requiring reoperation in 3.4%–27% of reports. Our report compares the initial placement of one Nuss bar versus two to prevent bar displacement. Subjects and Methods: An Institutional Review Board–approved, retrospective chart review was performed of all Nuss procedures performed from November 2000 through February 2010. Since November 2006, all initial Nuss procedures were started with the intent of placing two bars. Haller index, patient demographics, duration of surgery, length of stay, postoperative wound infections, and bar movement requiring reoperation were collected and compared for the one-bar versus two-bar patient populations. Results: In total, 85 Nuss procedures (58 with one-bar and 27 with two-bar primary Nuss procedures) were analyzed. Two attending pediatric surgeons performed all the procedures. Reoperation for bar movement when one bar was initially placed occurred in 9 patients (15.5%). No patients with initial placement of two bars required operative revision for a displaced Nuss bar (15.5% versus 0%, P = .05). Patient age and Haller index were not statistically different between groups. Conclusions: Our data demonstrate improved bar stability with no reoperative intervention when pectus excavatum is initially repaired with two Nuss bars. Primary placement of two bars has now become standard practice in our institution for correction of pectus excavatum by the Nuss procedure and would be our recommendation for consideration by other centers. This is a copy of an article published in the Journal of Laparoendoscopic and Advanced Surgical Techniques © 2012 Mary Ann Liebert, Inc.; Journal of Laparoendoscopic and Advanced Surgical Techniques is available online at: http://www.liebertonline.com. Tue, 01 May 2012 05:00:00 GMT http://hdl.handle.net/10027/8752 2012-05-01T05:00:00Z http://hdl.handle.net/10027/8750 Pediatric Obesity Holterman, Mark J.; Holterman, Ai-Xuan Le; Browne, Allen F. Obesity is a serious life-threatening disease that affects an increasing number of children in the developed world. Obese children suffer in many physical and psychosocial ways and their burden has important consequences to our society. Whereas obesity prevention is the ultimate goal, currently and into the foreseeable future, there will be a significant subset of our children suffering from significant life-altering weight comorbidities. Currently, non-surgical weight loss strategies have met with very limited success but weight management clinics that offer a surgical treatment option have been effective at achieving sustained weight loss and resolution of weight-related comorbidities. A collaborative multidisciplinary approach to the management and care of obese children is essential for success. Choosing a weight loss surgical strategy for children and adolescents should be patient specific and based on their age, severity of comorbidities and their BMI. We have developed a treatment algorithm for the care of obese adolescents as well as a plan for the development of aggressive treatment options for obese preteen aged children based on the limited existing literature and our experience treating adolescents and children at The New Hope Pediatric and Adolescent Weight Management Clinic between 2005 and 2011 at the University of Illinois College of Medicine. (3) As surgeons we must continually test our treatments, evaluate our results, and improve the care we offer our patients. NOTICE: this is the author’s version of a work that was accepted for publication in Surgical Clinics of North America. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Surgical Clinics of North America, Vol 92, Issue 3, 2012 DOI: 10.1016/j.suc.2012.03.007 Fri, 01 Jun 2012 05:00:00 GMT http://hdl.handle.net/10027/8750 2012-06-01T05:00:00Z http://hdl.handle.net/10027/8720 "Stayin' Alive": A Novel Mental Metronome to Maintain Compression Rates in Simulated Cardiac Arrests. Hafner, John W.; Sturgell, Jeremy L.; Matlock, David L.; Bockewitz, Elizabeth G.; Barker, Lisa T. Study Objectives: A novel and yet untested memory aid has anecdotally been proposed for aiding practitioners in complying with American Heart Association (AHA) CPR compression rate guidelines (at least 100 compressions per minute). This study investigates how subjects using this memory aid adhered to current CPR guidelines in the short and long term. Methods: A prospective observational study was conducted with medical providers certified in 2005 AHA guideline CPR. Subjects were randomly paired and alternated administering CPR compressions on a mannequin during a standardized cardiac arrest scenario. While performing compressions subjects listened to a digital recording of The Bee Gees song "Stayin' Alive", and were asked to time compressions to the musical beat. After at least five weeks, the participants were retested without directly listening to the recorded music. Attitudinal views were gathered using a post-session questionnaire. Results: Fifteen subjects (mean age 29.3 years, 66.7% resident physicians and 80% male) were enrolled. The mean compression rate during the primary assessment (with music) was 109.1 and during the secondary assessment (without music) was 113.2. Mean CPR compression rates did not vary by training level, CPR experience, or time to secondary assessment. Subjects felt utilizing the music improved their ability to provide CPR and felt more confident in performing CPR. Conclusions: Medical providers trained to use a novel musical memory aid effectively maintained AHA guideline CPR compression rates initially and in long term follow-up. Subjects felt the aid improved their technical abilities and confidence in providing CPR. NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Emergency Medicine . Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Emergency Medicine ,2012 DOI: 10.1016/j.jemermed.2012.01.026 Thu, 01 Mar 2012 06:00:00 GMT http://hdl.handle.net/10027/8720 2012-03-01T06:00:00Z